ABSTRACT
Treatment with programmed cell death 1 inhibitors is associated with a wide range of cutaneous immune-related adverse events, with lichenoid eruptions representing one of the major cutaneous toxicities. We describe the case of an 81-year-old man with metastatic melanoma treated with pembrolizumab who subsequently developed a delayed-onset generalized lichenoid dermatitis. After failing multiple lines of systemic immunosuppression, narrowband ultraviolet B (NBUVB) phototherapy three times per week for 17 sessions resulted in a significant clinical response in his cutaneous eruption and was well tolerated. NBUVB is a safe, lower-cost modality that induces local, skin-specific immunosuppression without the toxicities of traditional systemic immunosuppressive agents. To date, this is the first report of use of NBUVB in immune-related lichenoid dermatitis resistant to multiple standard therapies.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Immune Checkpoint Inhibitors/adverse effects , Lichenoid Eruptions/radiotherapy , Melanoma/drug therapy , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Skin Neoplasms/drug therapy , Ultraviolet Therapy , Aged, 80 and over , Humans , Lichenoid Eruptions/chemically induced , Lichenoid Eruptions/immunology , Lichenoid Eruptions/pathology , Male , Melanoma/immunology , Melanoma/secondary , Programmed Cell Death 1 Receptor/immunology , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Treatment OutcomeSubject(s)
Humans , Male , Middle Aged , Lichenoid Eruptions/complications , Lichenoid Eruptions/diagnosis , Lichenoid Eruptions/radiotherapy , Spectrophotometry, Ultraviolet , Ultraviolet Therapy/instrumentation , Ultraviolet Therapy/methods , Lichenoid Eruptions/physiopathology , Ultraviolet Therapy , Amyloidosis/complications , Amyloidosis/diagnosis , Amyloidosis/therapy , Hyperkeratosis, Epidermolytic/complications , Hyperkeratosis, Epidermolytic/therapySubject(s)
Dermatologic Agents/therapeutic use , Keratosis/pathology , Keratosis/therapy , Lichenoid Eruptions/pathology , Lichenoid Eruptions/therapy , Acitretin/therapeutic use , Administration, Cutaneous , Administration, Oral , Adult , Calcitriol/analogs & derivatives , Calcitriol/therapeutic use , Chronic Disease , Dermatologic Agents/administration & dosage , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Keratolytic Agents/therapeutic use , Keratosis/diagnosis , Keratosis/radiotherapy , Lichenoid Eruptions/diagnosis , Lichenoid Eruptions/radiotherapy , Lower Extremity/pathology , Male , Rare Diseases , Time Factors , Torso/pathology , Treatment Failure , Ultraviolet Therapy , Upper Extremity/pathologySubject(s)
Amyloidosis/radiotherapy , Laser Therapy , Lichenoid Eruptions/radiotherapy , Humans , Male , Middle AgedABSTRACT
BACKGROUND: In the South-west Thames region there were an unprecedented number of lichenoid tattoo reactions to red ink in patients who had visited a local tattoo parlour. The red ink was found to contain mercuric sulphide, a compound known to cause allergic reactions. Topical Dermovate (clobetasol propionate 0.05%, GlaxoWellcome) ointment alone had little impact. OBJECTIVES: To investigate whether the Q-switched 532 nm Nd:YAG laser could produce permanent flattening of the reaction. METHODS: This was an open nonrandomized clinical trial. Biopsies were taken from the lichenoid areas within the tattoos. Subjects were patch tested to 1% ammoniated mercury in petrolatum prior to treatment with the Q-switched 532 nm Nd:YAG laser. Laser treatments were delivered at 6-weekly intervals by a single operator. Patients also applied topical Dermovate between treatments. Therapy was discontinued when the lesions flattened. Clinical photographs were assessed at baseline and prior to each laser treatment. RESULTS: Seven patients with Fitzpatrick skin types I-III were enrolled in the study (four females, three males, mean age 39 years). All patients completed the trial. Patch testing to mercury was universally negative at 48 and 96 h. Substantial flattening and depigmentation of the red ink within the tattoos was noted after six laser treatments. No adverse effects were recorded. CONCLUSIONS: The Q-switched 532 nm Nd:YAG laser in combination with topical Dermovate ointment is a safe and effective method of treating red ink tattoo reactions.
Subject(s)
Clobetasol/analogs & derivatives , Coloring Agents/adverse effects , Ink , Laser Therapy , Lichenoid Eruptions/etiology , Tattooing/adverse effects , Administration, Topical , Adult , Anti-Inflammatory Agents/therapeutic use , Clobetasol/therapeutic use , Combined Modality Therapy , Female , Follow-Up Studies , Glucocorticoids , Humans , Lichenoid Eruptions/pathology , Lichenoid Eruptions/radiotherapy , Male , Mercury Compounds/adverse effects , Middle AgedABSTRACT
We report a 44-year-old male with generalized progressive scleromyxoedema treated by total skin electron beam therapy (TSEBT) which produced a marked improvement in the skin lesion. TSEBT can provide effective treatment for patients with widespread skin involvement in scleromyxoedema.
Subject(s)
Electrons/therapeutic use , Lichenoid Eruptions/radiotherapy , Scleroderma, Localized/radiotherapy , Adult , Humans , Lichenoid Eruptions/pathology , Male , Scleroderma, Localized/pathologyABSTRACT
We report a patient with Arndt-Gottron's scleromyxoedema whose skin lesions responded to electron-beam therapy. This treatment appears to be effective in improving the cutaneous signs and functional impairment of this disease.
